Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Yonsei Med J. 2021 Oct;62(10):928-935. doi: 10.3349/ymj.2021.62.10.928.
In young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV).
We retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bahren system.
One hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%).
Remnant collateral veins of the internal spermatic vein (ISV) (Bahren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bahren type 4) and is unidentifiable without venography.
在患有精索静脉曲张的年轻患者中，保留精索内动脉可能有利于追赶生长，但也可能增加治疗失败的可能性。术中静脉造影术可降低精索静脉结扎术后未封闭静脉残留的可能性。我们分析了术中静脉造影术显示的残留静脉的特征，以研究保留动脉的精索静脉结扎术（ASV）失败的原因。
我们回顾性分析了 2005 年 1 月至 2017 年 12 月期间接受术中静脉造影术的 18 岁或 18 岁以下精索静脉曲张患者的临床特征和结局。在精索静脉曲张结扎术中，进行术中静脉造影术以区分静脉和其他结构。发现任何未封闭的静脉均用 Bahren 系统结扎和分类。
162 例患者接受了术中静脉造影术：153 例（94.4%）为原发性精索静脉曲张，9 例（5.6%）为复发性精索静脉曲张。105 例（64.8%）行开放精索静脉曲张结扎术，57 例（35.2%）行腹腔镜精索静脉曲张结扎术。第一次结扎后发现残留静脉 51 例（31.2%），其中 Bahren 类型 3 和 4 分别为 46 例（90.2%）和 5 例（9.8%）。5 例（3.1%）患者出现精索静脉曲张复发，1 例（0.6%）为持续性复发，4 例（2.5%）为复发性复发。
残留的精索内静脉（ISV）（Bahren 类型 3）侧支静脉是 ASV 失败的最常见原因。在少数患者中，精索外静脉在较高水平与 ISV 融合（Bahren 类型 4），如果没有静脉造影术则无法识别。
